No abstract available.
Echocardiography*

PURPOSE: This study examined the predictive factors enabling access to children's oral health care at the level of financial barriers, beliefs, and the provider. METHODS: In-depth interviews were conducted with 320 immigrant mothers of low-income families regarding their use of oral health services for children aged four to eight years old. Access to oral health care was measured with frequency of planned dental visits, continuity of care, and age at first visit to dentist. RESULTS: The mother took her child to the dentist at a younger age if she received referrals to a dentist from pediatrician. Regular dental visits were significantly related to household income, provider availability on weekends, and insurance coverage. The extended clinic hours in the evenings, and the belief in the importance of the child's regular dentist visits increased the likelihood of continuing care. The mothers perceiving a cost burden for the child's dental care were also less likely to return to the dentist. CONCLUSION: The available care delivery system, coordinated medical care, and health beliefs were among important predictors of the health service use. The study findings suggest need for culturally competent dental health interventions to enhance access to oral health care among particularly vulnerable populations such as low-income children in Korean communities.
Adult ; Attitude to Health/*ethnology ; Chicago ; Child ; Child, Preschool ; Clinical Competence/standards ; Continuity of Patient Care/standards ; Cultural Diversity ; Dental Care for Children/economics/*utilization ; Emigration and Immigration ; Female ; Focus Groups ; Health Care Surveys ; Health Knowledge, Attitudes, Practice ; Health Services Accessibility/standards ; Health Services Needs and Demand ; Hispanic Americans/education/*ethnology ; Humans ; Mexico/ethnology ; Mothers/education/*psychology ; Multivariate Analysis ; Nursing Methodology Research ; Poverty/economics/*ethnology ; Puerto Rico/ethnology ; Questionnaires

158 cases of pulmonary metastasis having satisfactory histological proof of the primary malignant tumor, the frequency and pattern of which were analysed by conventional radiologically. The results are as follows: 1. The frequency of pulomonary metastasis according to the primary sites was 24%(38/158) hepatobiliary system,19.6%(31/158) gastrointestinal tract, 18.9%(30/158) uterine cervix and 12%(13/158) head and neck. 2. Pulmonary metastatic pattern showed nodular type 74% (117/158), granular type 10.1%(16/158), streaky type 9.5%(15/158),hilar enlargement 3.8%(6/158), patchy type 1.9% (3/158) and others 0.6%(1/158). Of all these type, nodular type was predominant. 3. The nodular type of pulmonary metastasis was classified into less than 10 nodules56.4%(66/17), 10-50 nodules 25.6%(30/117), more than 50, 17.9%(21/117), less than 1cm 12.8%(15/117) and more than5cm in 5.2%(1/117) of the cases. 4. The size of nodule was 1-3cm 36.6%(43/117), 2-3cm 20.5%(24/117), less than 1cm12.8%(15/117) and more than 5cm in 5.2%(1/117) of the cases. 5. Most cases of pulmonary metastasis involved bothlung fields 69.2%(110/58). Others were right lung field only 17.7% (28/158), left lung only 12.7%(20/158). 6. Theages between 40 and 70 represented 79.8%(126/158) of the cases and the raio of male and female was about 1.5:1.
Cervix Uteri ; Female ; Gastrointestinal Tract ; Head ; Humans ; Lung ; Male ; Neck ; Neoplasm Metastasis

Pulmonary edema is a recognized complication of acute airway obstruction, laryngospasm, especially after endotracheal extubation. It usually follows relief of the obstruction and is likely to be of noncardiogenic origin. The mechanism by which an upper airway obstruction causes pulmonary edema is likely due to the combination of the increased reduction of intrapulmonary pressure, increased capillary permeability and hypoxia. We present a case of pulmonary edema that occurred in an adult patient after upper airway obstruction following extubation of the trachea.
Adult ; Airway Extubation* ; Airway Obstruction* ; Anoxia ; Capillary Permeability ; Edema ; Humans ; Laryngismus ; Lung ; Pulmonary Edema* ; Trachea

The incidence of anaphylaxis to intravenous agents used for general anaesthesia is reported as about 1 : 6000. Despite appropriate treatment, mortality is reported as about 6%, thus it is important to try to minimize the risk by prevention. A adequate investigation, communication and avoidance of drugs responsible with the use of pretreatment and alternative techniques, the risk of second reaction should be reduced. A patient who has the history of anaphylactic shock to thiopental, for the induction of anesthesia was scheduled for subtotal gastrectomy. Skin test confirmed that she had a hypersensitivity to a thiopental. We performed combined general and spinal anesthesia. She was premedicated with dexamethasone and pheniramine malate in the operating room. Spinal blockade is up to T6 by 0.5% tetracaine. Then, anesthesia was induced with propofol and midazolam. There is no need for muscle relaxant drugs and anesthesia was maintained with isoflurane, N2O, O2. Subtotal gastrectomy was done without event. Combined general and spinal anesthesia affords the anesthesiologist the opportunity to lower the local anesthetic doses, to avoid using many kinds of intravenous drugs (muscle relaxants, opioids, benzodiazepine, etc.) and to approach a kind of anesthesia that is close to the ideal anesthesia.
Analgesics, Opioid ; Anaphylaxis* ; Anesthesia ; Anesthesia, Spinal ; Benzodiazepines ; Dexamethasone ; Gastrectomy ; Humans ; Hypersensitivity ; Incidence ; Isoflurane ; Midazolam ; Mortality ; Operating Rooms ; Pheniramine ; Propofol ; Skin Tests ; Tetracaine ; Thiopental*

Intracranial gliomas were found more commonly in childhood(70 to 80%) than in adulthood(40 to 45%). The common infratentorial tumors in children were cerebellar astrocytoma(26.9%), medulloblastoma(18.5%) and brain stem glioma(10.5%). Brain stem gliomas were infiltrating type of tumor and frequently involved the pons and medulla. An almost pathognomic syndrome of the brain stem gliomas consists in the presences of multiple bilateral cranial nerve abnormalities in combination with involving signs of pyramidal tract and cerebro-dentato-rubro-thalamic tract in the absence signs of increased ICP, especially in the early stage. These tumors take grave course because of clinical malignancy and lack of definite therapy. Once diagnosed, radiation therapy was at best palliative treatment. Sometimes surgical therapy could be attempted to find out curable cysts. We have been experienced in a case of brain stem glioma recently that was confirmed with an autopsy;astrocytoma grade II to III, microscopically.
Brain Stem* ; Brain* ; Child ; Cranial Nerves ; Glioma* ; Humans ; Infratentorial Neoplasms ; Palliative Care ; Pons ; Pyramidal Tracts

BACKGROUND: Propofol can produce a dose-dependent reduction in blood pressure by providing titratable sedation and rapid recovery. It has been reported that a combination of midazolam and propofol resulted in the significant reduction in the total dose of propofol needed. It was hypothesized that the addition of low-dose midazolam to propofol may provide sufficient sedation without compromising the hemodynamic stability. METHODS: A total of 40 consecutive patients were randomly assigned to one of two groups (n = 20 each). Group M-P received a bolus of 0.02 mg/kg of midazolam, followed by a propofol infusion with a fixed target concentration of 1.0microgram/ml. Group P received only a propofol infusion with an initial target plasma concentration of 2.5microgram/ml. Subsequent titration of the infusion rates in Group P or the additional midazolam boluses in Group M-P were made in order to maintain a predetermined sedation level. RESULTS: In Group P, a mean dose of 5.4 +/- 0.7 mg/kg/h propofol was used compared with 2.7 +/- 0.5 mg/kg/h in Group M-P (P<0.0001, plus additional 2.96 +/- 1.8 mg of midazolam). Ephedrine was administered to 15 patients in Group M-P and 17 patients in Group P. Recovery was significantly fast (Group P, 6.8 +/- 2.9 min vs. Group M-P, 9.8 +/- 4.4 min, P<0.05). CONCLUSIONS: Sedation with propofol plus midazolam requires a lower total dose of propofol compared with propofol alone but has no superior hemodynamic stability. A further study using younger patients and combinations of different doses of each drug will be needed.
Anesthesia, Spinal* ; Blood Pressure ; Ephedrine ; Hemodynamics ; Humans ; Hypotension ; Midazolam ; Plasma ; Propofol* ; Prospective Studies*

PURPOSE: The magnetic resonance(MR) appearance of 23 biopsy-proven meningiomas were retrospectively evaluated and correlated with histologic pattern ;fibroblastic, transitional, syncytial, angioblastic. MATERIALS AND METHODS: Twenty three patients with biopsy-proven meningiomas were examined with MR imaging over a 3 years period. Images were assessed for average T1, T2 intensity score(1-5), degree of edema, calcification, cyst formation or necrosis, and dural tail sign. RESULTS: Tl-weighted images showed only one significant correlation between fibroblastic type and angiobiastic type (p<0.04). Angioblastic type was more hypointense than gray matter(1.83/isointense to gray 3) on T1-weighted image. Syncytial and angioblastic tumors had average T2 intensity scores much higher than those of fibroblastic and transitional types. All three cases of angioblastic tumors had shown severe edema. Calcified lesions were much more common in transitional and fibroblastic types than in syncytial and angioblastic types. CONCLUSION: MRI is a helpful diagnostic imaging modality with good correlation between its MR findings and histologic patterns.
Diagnostic Imaging ; Edema ; Fibroblasts ; Humans ; Magnetic Resonance Imaging* ; Meningioma* ; Necrosis ; Retrospective Studies

OBJECTIVES: The aim of this study was to evaluate and quantify the risk of both individual and combined health behaviors on premature mortality in middle aged men in Korea. METHODS: In total, 14 533 male subjects 40 to 59 years of age were recruited. At enrollment, subjects completed a baseline questionnaire, which included information about socio-demographic factors, past medical history, and life style. During the follow-up period from 1993 to 2008, we identified 990 all-cause premature deaths using national death certificates. A Cox proportional hazard regression model was used to estimate the hazard ratio (HR) of each health risk behavior, which included smoking, drinking, physical inactivity, and lack of sleep hours. Using the Cox model, each health behavior was assigned a risk score proportional to its regression coefficient value. Health risk scores were calculated for each patient and the HR of all-cause premature mortality was calculated according to risk score. RESULTS: Current smoking and drinking, high body mass index, less sleep hours, and less education were significantly associated with all-cause premature mortality, while regular exercise was associated with a reduced risk. When combined by health risk score, there was a strong trend for increased mortality risk with increased score (p-trend < 0.01). When compared with the 1-9 score group, HRs of the 10-19 and 20-28 score groups were 2.58 (95% confidence intervals [CIs], 2.19 to 3.03) and 7.09 (95% CIs, 5.21 to 9.66), respectively. CONCLUSIONS: Modifiable risk factors, such as smoking, drinking, and regular exercise, have considerable impact on premature mortality and should be assessed in combination.
Adult ; Alcohol Drinking/mortality ; Body Mass Index ; *Cause of Death ; Cohort Studies ; Exercise/physiology ; Follow-Up Studies ; *Health Behavior ; Humans ; Korea ; Life Style ; Male ; *Men's Health ; Middle Aged ; Proportional Hazards Models ; Risk Factors ; Smoking/mortality

BACKGROUND: Tracheal extubation, as well as intubation, causes hypertension and tachycardia. The aim of this study was to compare the effect of verapamil, lidocaine to lidocaine-verapamil combination in attenuating the cardiovascular changes following tracheal extubation and emergence from anesthesia. METHODS: Eighty patients (ASA physical status 1) were randomly assigned to one of four groups (n=20 each) ; saline (control), 1 mg/kg lidocaine, 0.05 mg/kg verapamil and lidocaine-verapamil combination. These medication were given intravenously 2 min before tracheal extubation. Changes in blood pressure and heart rate were measured following tracheal extubation. RESULTS: Lidocaine, verapamil and their combination all attenuated the changes of heart rate and blood pressure. The inhibitory effect on changes of heart rate and blood pressure were miximum in group of the combination of lidocaine and verapamil. CONCLUSION: We conclude that the verapamil 0.05 mg/kg and lidocaine 1 mg/kg given iv concomitantly 2 min before tracheal extubation is a more effective prophylaxis than verapamil or lidocaine for attenuating the cardiovascular changes associated with tracheal extubation.
Airway Extubation* ; Anesthesia ; Blood Pressure* ; Heart Rate* ; Heart* ; Humans ; Hypertension ; Intubation ; Lidocaine* ; Tachycardia ; Verapamil*